Imaging Pre-Certification Specialist

The US Oncology Network • Knoxville, TN

3d • Onsite

About The Position

As a Pre-Certification Specialist, you will assist our providers with obtaining prior authorization from various insurance carriers for ordered medications and treatments. In this Monday – Friday role, you use your expertise to obtain authorization for patient treatments and break down barriers that might prevent that authorization. Your customer service skills will allow you to respectfully communicate with our payors, ensuring there is no delay in the patient’s treatment plan. You will work alongside a team of dedicated individuals who will help you troubleshoot issues. As a point of contact for our clinic teams, you are responsible for fielding questions or assisting with additional needs. While it can be challenging to balance the persistence needed to work with various payors and the empathy required for our patients, your professionalism allows you to do just that!

Requirements

• Knowledge of chemotherapy, immunotherapy, or other infusion treatment authorization requirements for all types of payors.
• Exceptional customer service skills, including communicating respectfully, thoroughly listening, and asking appropriate questions.
• Proficiency with electronic health records, payor portals, and Microsoft Office (Outlook, Word, Excel, etc.).
• High school diploma or equivalent.
• At least one year of direct experience in a similar position (pre-certification, benefit financial counseling, benefits verification, referral specialist, medical assistant, LPN).
• Sufficient manual dexterity for operating office equipment (keyboard, telephone, copier, etc.).
• Vision and hearing must be adequate for viewing computer screens for prolonged periods and hearing in-person and phone conversations.
• Minimum two (2) years medical insurance verification and authorization required.

Nice To Haves

• Associate’s degree in a business-related field.
• Prior experience as a medical assistant or LPN.
• LPN state license and registration preferred.
• Billing and coding experience preferred.

Responsibilities

• Obtain prior authorization from various insurance carriers for ordered medications and treatments.
• Communicate respectfully with payors to ensure no delay in patient treatment plans.
• Troubleshoot issues with a team of dedicated individuals.
• Act as a point of contact for clinic teams, fielding questions and assisting with additional needs.
• Communicate and provide prompt feedback to physicians, management, and other clinical staff members regarding restrictions, special requirements, and other possible payor issues related to specific insurance plans.
• Research alternative solutions to obtaining authorizations and recognize trends with specific treatments and payors.
• Assist with any additional needs as they arise.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED